A new type of triad osteotomy for the treatment of
Professor Wang Hanlin of department of pediatric orthopedics, the third affiliated hospital of Hebei Medical University adopted a new type of triad osteotomy for the treatment of subluxation of the hip joint caused by congenital aseptic necrosis of the femoral head (fig.1) and dysplasia of the acetabulum, enabling a thorough disappearance of the painful symptoms and complete recovery of gait.
Based on the latest development of Tonnis triad osteotomy of the acetabulum in foreign literature, Professor Wang further modified the position of the patient on table during the operation, the surgical approach, the rotation angle of the acetabulum and the pre- and post-operative managements. He adopted a new type of "traid osteotomy". Professor Wang also designed by himself a set of specific instruments thereby augmented the surgical indications.
, 百拇医药
Professor Wang recommended that the key points of the procedure were osteotomy of the ramus of ischium the pubic branch and the ilium (the traid osteotomy as shown in the fig. 2 at the base of the acetabulum, lateral inferior rotation of the acetabulum, coverage of the femoral head to achieve concentric reduction of the femoral head and the acetabulum and stabilization of the hip joint, elimination of joint pain, recovery of the limb length and thus solving the problem of limping. Preoperatively, a specially self designed instrument was used for soft tissue release and supra-condylar femoral traction; the patient was placed on the side at first during the surgical procedure, an incision was made between the greater trochanter and the ischial tuberosity. Then the patient was placed in supine position and another incision was made at the isolateral inguinal region; under direct vision, osteotomy close to the base of the acetabulum was carried out at the superior ischial ramus, the superior ramus of pubis and the ilium. Following loss of bony linkage of the acetabulum, anterior, lateral and distal rotational displacement was done, mainly carried out the lateral rotation of the acetabulum until a complete coverage of the femoral head was attained. The ilium bone graft was then procured and multiple pieces of K wire were used for a satisfactory fixation (fig.3). Postoperatively a hip spica was applied for the fixation, simultaneously skin traction of the diseased limb was used for two weeks and then functional exercise was started; 8 weeks later the patient was allowed ambulatory.
, 百拇医药
Among the 16 cases treated by Professor Wang, there were 11 cases of congenital subluxation of the hip joint associated with congenital dysplasia of the acetabulum, 4 cases of subluxation of the hip secondary to femoral head necrosis and one case of congenital complete dislocation of the hip. The results of the surgical treatment showed that the application of this new type of surgical procedure not only shortened the operation period from the original 4 hours to not more than 2 hours, but also reduced the amount of blood transfusion from the original 800 ml to around 200 ml. The most notable virtue was taking advantage of the change of the acetabulum position to obtain the maximum acetabulum and femoral head coverage to approach to a nearly anatomical reduction, allowing weight bearing of the diseased limb in compliance with the requirement of biodynamics thereby remarkably improved joint function. Postoperative x-ray examination showed that the femoral head had satisfactory coverage by the acetabulum, the break of Shenton line recovered its continuation. The acetabulum index decreased approximately in an average of 20o. In the follow-up period of nearly 10 years, notable improvement in joint pain, limping, limb shortening and symptoms of inertia etc were seen in all the 16 patients., 百拇医药
Based on the latest development of Tonnis triad osteotomy of the acetabulum in foreign literature, Professor Wang further modified the position of the patient on table during the operation, the surgical approach, the rotation angle of the acetabulum and the pre- and post-operative managements. He adopted a new type of "traid osteotomy". Professor Wang also designed by himself a set of specific instruments thereby augmented the surgical indications.
, 百拇医药
Professor Wang recommended that the key points of the procedure were osteotomy of the ramus of ischium the pubic branch and the ilium (the traid osteotomy as shown in the fig. 2 at the base of the acetabulum, lateral inferior rotation of the acetabulum, coverage of the femoral head to achieve concentric reduction of the femoral head and the acetabulum and stabilization of the hip joint, elimination of joint pain, recovery of the limb length and thus solving the problem of limping. Preoperatively, a specially self designed instrument was used for soft tissue release and supra-condylar femoral traction; the patient was placed on the side at first during the surgical procedure, an incision was made between the greater trochanter and the ischial tuberosity. Then the patient was placed in supine position and another incision was made at the isolateral inguinal region; under direct vision, osteotomy close to the base of the acetabulum was carried out at the superior ischial ramus, the superior ramus of pubis and the ilium. Following loss of bony linkage of the acetabulum, anterior, lateral and distal rotational displacement was done, mainly carried out the lateral rotation of the acetabulum until a complete coverage of the femoral head was attained. The ilium bone graft was then procured and multiple pieces of K wire were used for a satisfactory fixation (fig.3). Postoperatively a hip spica was applied for the fixation, simultaneously skin traction of the diseased limb was used for two weeks and then functional exercise was started; 8 weeks later the patient was allowed ambulatory.
, 百拇医药
Among the 16 cases treated by Professor Wang, there were 11 cases of congenital subluxation of the hip joint associated with congenital dysplasia of the acetabulum, 4 cases of subluxation of the hip secondary to femoral head necrosis and one case of congenital complete dislocation of the hip. The results of the surgical treatment showed that the application of this new type of surgical procedure not only shortened the operation period from the original 4 hours to not more than 2 hours, but also reduced the amount of blood transfusion from the original 800 ml to around 200 ml. The most notable virtue was taking advantage of the change of the acetabulum position to obtain the maximum acetabulum and femoral head coverage to approach to a nearly anatomical reduction, allowing weight bearing of the diseased limb in compliance with the requirement of biodynamics thereby remarkably improved joint function. Postoperative x-ray examination showed that the femoral head had satisfactory coverage by the acetabulum, the break of Shenton line recovered its continuation. The acetabulum index decreased approximately in an average of 20o. In the follow-up period of nearly 10 years, notable improvement in joint pain, limping, limb shortening and symptoms of inertia etc were seen in all the 16 patients., 百拇医药